Dr Anthony Pryce

Following the lecture on the social processes of becoming ill, we must:

Explore the variation and issues involved in the responses to illness

Identify the impact of chronic illness on people’s lives

Consider the issue of illness as challenge to self-identity

Explore the impact of contested illnesses such as RSI

- of the impact on you if you were diagnosed with:

Cancer

HIV

Epilepsy

Heart disease

Depression

Include gathering information from a variety of sources - friends, experts, Internet, support groups in order to make sense of what is happening

This is part of ‘narrative reconstruction’ (Williams, 1989) or stories that explain the medical condition and the altered condition and sense of new identity as patient/sufferer/victim - Why me? and Why now?

Stories are constructed that often try to associate social and personal events with the onset or emergence of symptoms or illness

Contemporary life puts emphasis on control of life so why might social explanations be ignored by doctor? What makes sense to the individual may not ‘fit’ with medical model.

Narratives as believing

The transformation of a range of symptoms into a coherent disease that can be named, involves convincing:

doctors

partners/family

colleagues

employers

if the disease label is to confirm new social role

Generally work within medical model in which the symptoms have to confirm to particular illness categories if a diagnostic label is applied. Where ‘truth’ is contested e.g. RSI the doctor may be reluctant to accept patient perspective/experience

Some doctors may support or collude with patients, giving labels to gain time off work e.g. hyperemesis or anxiety state

Revisit Parson’s (1951) Functionalist perspective - Illness as deviance

The sick role identifies two rights:

the exemption from normal social roles

from responsibility for their own state

and two obligations:

to want to get well speedily

to consult expert medical opinion

Sometimes these can be most difficult if the disease label is stigmatising or psychological:

schizophrenia

agoraphobia

alcoholism

HIV

ME

Work/organisational culture may be hostile to some diseases where symptoms are not overt e.g. slacking or shirking

Gaining legitimate illness status is essential to enable time off, hospital appointments

Illness is usually only accepted by work colleagues when medical advice has been sought and seen to be obtained!

These are the other gatekeepers of Time and Income as well as enabling continuity and social status through job role.

Convincing employers requires doctors support through sick notes that legitimise absence. Some employers remain sceptical where some illnesses are more genuine/real than others.

Similarly, some health practitioners have more status than others as gatekeepers

Illness might lead to hardship and/or might condemn individual to stay within circumstances that exacerbate the problem!

Sick pay is now not refundable by employers so might harden their attitudes to employing people with poor sickness records - including nurses!

Some illnesses that cause temporary or permanent loss of work might produce compensation. However, the self-employed may experience hardship because they cannot work and may have no insurance or those who depend on overtime to enhance earnings may suffer deprivation.

Surgery or physical and psychological aspects of illnesses and their treatment might cause disruption for the person who might:

learn new skills of self care - injections, dressings

Disruption to home life - Alzheimers, disabilities, progressive illness or terminal care

Social relationships - invalid therefore ‘invalid’

Employment - loss or reduced career options

The ill person may have to reconstruct their sense of self (Bury 1991, Kelly 1992)

The ‘self’ is a product of social structure and individual agency(action)

Illness affects the self because of the meanings and consequences of the illness and the disease process - ’I am not the person I was - ’

the changes in the self

in the hospital - support and clinical constructions of disease

discharge - may be frightening where ‘normal’ activities of life become new

depression, denial, anger, fear of rejection

reconstructing new social identity e.g. as person with disability

Some people seek self-help networks others try to pass as ‘normal’ - the need to carry on

Private self/public identity - stigma and fear of labelling and disclosure (Goffman)

Life of uncertainty, (dis)continuities

Survival narratives also identify life-threatening illnesses as transformative